Archives of Suicide Research最新文献

Background: Suicide is a significant but understudied public health concern in developing nations like Pakistan, where risks factors have not been investigated by mixed methods studies. Hence, we aimed to explore the risk factors for suicide based on a mixed methodology.

Methods: This study followed a mixed methods convergent component design. A retrospective case-control psychological autopsy with a semistructured interview protocol was performed. Additionally, health professionals' opinions on the psychiatric risk factors for suicide were assessed through qualitative interviews. Data were collected between 2021 and 2022 and analyzed by SPSS (V-25) and thematic analysis (NVIVO-12 Plus).

Results: Based on the mixed methods meta-inferences, suicidal ideation; depression; hopelessness; social isolation; previous history of self-harm and traumatic experiences; lack of motivation; purposelessness; feeling like a burden; substance abuse; impulsivity; anger; anxiety; psychiatric disorders such as personality disorders, bipolar disorder, schizophrenia, gaming addiction, and eating disorders; and family history of psychiatric illness were identified as risk factors for suicide.

Conclusion: More must be learned about the mental health components contributing to suicide and the culturally appropriate prevention methods used in Pakistan. This study reveals novel targets for suicide prevention and may aid policymaking by providing a better understanding of predictors and specific psychiatric characteristics of suicide in Pakistan.

This study utilized latent class analysis to identify latent groups of individuals, reflecting the expanded dimensions of suicidality, which encompass not only one's own suicidality but also that of significant others. Drawing on data from Wave 3 and Wave 5 of the National Longitudinal Study of Adolescent to Adult Health, the analysis included 3215 individuals. The LCA revealed three distinct latent classes: the Exposed, the Suicidal, and the Non-Suicidal and Unexposed. Subsequent analysis using the Kruskal-Wallis test found significant longitudinal differences in mental health outcomes, including depression and suicidality, among these three latent classes over a 15-year period. Specifically, the Suicidal Class scored significantly higher than the Exposed Class and the Non-Suicidal and Unexposed Class for both depression and suicidality. Additionally, the Exposed Class scored significantly higher than the Non-Suicidal and Unexposed Class. These findings have implications for mental health researchers and practitioners, including the implementation of preventive and postventive interventions in the early stages, as well as the engagement of individual, family, and community partnerships in these interventions.

Objective: Guided by Minority Stress and Interpersonal and Ideation-to-Action Theories of Suicide, we sought to identify latent classes of painful and provocative events (PPEs), determine associations with class membership, and assess class-specific suicide attempt prevalence among cisgender sexually minoritized men (SMM) with suicidal ideation in the United States.

Method: Using data collected from October 2020 to January 2021 from 1617 SMM reporting past-year suicidal ideation, we performed latent class analysis on 22 PPE items spanning sexual behavior stigma, substance use, high-risk sex, and food and housing insecurity. We used multinomial logistic regression to assess associations with class membership and the Bolck-Croon-Hagenaars method to estimate class-specific past-year suicide attempt prevalence.

Results: Participant mean age was 29 years, 63% (n = 1010) were non-Hispanic white, and 14% (n = 221) reported a past-year suicide attempt. Five classes emerged: Extreme (7%, n = 113), featuring pervasive stigma, polysubstance use, high-risk sex, and food and housing insecurity; Severe/marijuana (15%, n = 236), featuring pervasive stigma, alcohol use, marijuana use, high-risk sex, and food insecurity; Severe (18%, n = 296), featuring the same PPEs minus marijuana use; Moderate (17%, n = 267), featuring family stigma, verbal harassment, some polysubstance use, and high-risk sex; and Mild (44%, n = 705), featuring family and friends stigma, verbal harassment, and alcohol use. Significantly higher suicide attempt prevalence emerged in the Extreme/Severe classes (12-16%) relative to the Mild/Moderate classes (2%).

Conclusions: Stigma and substance use were common across classes, implicating both as key factors shaping suicide risk among SMM. Holistic, multipronged, tailored interventions targeting stigma, substance use, and other PPEs are needed.

Objective: The Suicide Crisis Syndrome (SCS) has accumulated support as an indicator of suicide risk in patient settings; however, it has not been evaluated in military/veteran populations. The present study tested the factorial structure, measurement invariance, latent mean differences, and incremental validity of a SCS proxy variable developed from the Military Suicide Research Consortium's (MSRC) Common Data Elements (CDE).

Method: A secondary data analysis of 6,556 adults (40.5% current service members, 27.0% veterans, 26.6% civilians) who participated in MSRC-funded studies was conducted. CDE items were selected to form a SCS proxy, which was tested in subsequent analyses.

Results: A bifactor model exhibited superior model fit to alternative configurations. This model was partially invariant across those with differing histories of suicide and military service. Individuals with a history of suicidal ideation or attempts had more severe SCS symptoms than those without such history, and the SCS factor was incrementally related to lifetime suicide attempts and their characteristics above other relevant factors.

Conclusions: These findings provide evidence for the generalizability of the SCS to military service member and veteran populations, as well as the potential utility of proxy measures as an assessment tool in settings in which lengthy measures may be prohibitive.

Objective: Suicide prevention professionals and programs have focused on reaching not only individuals with suicide ideation, but also family, friends, and other acquaintances, referred to as suicide gatekeepers. Social media provide platforms that allow health communicators to reach a large population. This research focuses on examining and testing the most effective message framing (how the message provides a reward or consequence for the receiver) and message construct (precise focus and wording of a message) for social media posts intended to positively influence suicide gatekeeper intervention behavior on behalf of a friend or peer.

Method: An experiment tested the influence of message construct (between subjects) and message frame (within subjects). The experiment randomized the 1285 participants between the ages of 18 and 34 into the three message construct conditions (significance, preventability, and beneficence).

Results: The results suggest gain-framed messages have a more positive influence than loss-framed messages on all social media message outcome variables (likelihood of social media message engagement, perceived message effectiveness, self-efficacy, response efficacy, empathy, and behavioral expectation), and state empathy mediates the relationship between message frame and these variables. Message construct condition and other mediation results were less substantial, although some evidence suggests that the significance message construct may increase social media message sharing and perceived message effectiveness.

Conclusion: Results show strong evidence of the effectiveness of using gain frames in social media messages aimed at suicide gatekeepers. Other considerations include highlighting the significance of suicide and utilizing empathy appeals to strengthen social media message engagement and behavioral intention.

Introduction: Police records are an important resource in absence of a national suicide database in the context of Pakistan. We studied suicides reported across three districts of Gilgit-Baltistan (GB); causes, patterns of suicidal behaviors, and classification processes.

Methods: A retrospective survey of police records from GB between 2012 and March 2022 was completed using a structured questionnaire that included demographic characteristics, possible causes, and forensic details. Descriptive statistics and a chi-square test of association were applied. This study was approved by the Institutional Review Board of Shifa International Hospital, Islamabad (IRB 0210-22).

Results: In total, 340 cases of suicides were registered. Among them, 53% (n = 179) were females, 59% (n = 202) unmarried and 40% (n = 136) below 20 years of age. Stress and mental illnesses were reported in 73% (n = 247) cases. Common methods of suicide were hanging (41%; n = 141) and firearms (25%; n = 85). More men compared to women attempted suicide by firearms while more women died by drowning or poisoning. Greater proportion of individuals who were unmarried and had formal education died by suicide compared to their demographic counterparts. Number of individuals having a "mental illness" was higher in men while significantly more women were affected by "domestic stressors." Seven (2.9%) cases reported between 2021 and 2022 were reclassified as homicides.

Conclusion: Suicide is more common among females compared to males, unmarried compared to married, and younger population compared to older population. Cases reclassified as homicide highlight the need for rigorous forensic inquiry of each suicide. Development of effective suicide prevention strategies is urgently required.

Objective: Sexual and gender minority adolescents face elevated rates of self-injurious thoughts and behaviors (SITBs) relative to peers, yet fewer studies have examined risk in these youth, and reasons for higher risk remain unclear. Modeling SITBs using traditional statistical models has proven challenging. More complex machine learning approaches may offer better performance and insights. We explored and compared multiple machine learning models of suicide ideation, suicide attempts, and non-suicidal self-injury-both past-year frequency and dichotomous lifetime occurrence-among adolescents of diverse gender identities and sexual orientations.

Method: Data came from a large adolescent survey (N = 2,452) including psychological and demographic features. We compared prediction performance between generalized linear models, random forest models, and gradient boosting decision tree models using the full sample.

Results: Contrary to hypotheses, we found that these models generally performed comparably. We then selected the best-performing model families to run follow-up comparisons between cisgender and gender minority adolescents and between heterosexual and sexual minority adolescents. Depression was consistently the top-ranked feature across all models save one, in which discrimination was the top-ranked feature for lifetime occurrence of suicide attempt in the gender minority group. In addition, loneliness was more important in the gender minority group relative to the cisgender group for models of suicidal ideation.

Conclusion: Discrimination and loneliness emerged as important features in predicting SITBs amongst gender minorities. Future work should examine these factors both as possible statistical predictors of SITB risk and as treatment targets for gender minority youth.

Objective: Globally, drug-related deaths impact both urban and non-urban areas. In Australia, regional areas face a concerning rise in drug-induced fatalities and suicides, exacerbated by structural factors like limited services and stigma. We sought to explore the experiences of people who use drugs (PWUDs) in regional Queensland to understand the structural vulnerabilities influencing drug-induced deaths.

Methods: The sample comprised 19 PWUDs from regional Queensland, Australia who had experienced overdose. Semi-structured interviews explored participants' overdose experiences and contributing factors, focusing on regionality. Iterative coding was used to develop thematic categories.

Results: Participants highlighted the complex interplay of trauma, coping and drug use influencing overdose dynamics. Regional challenges, including limited access to support services, exacerbate risks for PWUDs. Structural inequalities perpetuate cycles of harm, with rural areas disproportionately affected. Participants emphasized the need for systemic changes to facilitate effective suicide prevention efforts, advocating for enhanced service engagement and legislative reforms.

Conclusions: These findings challenge systemic factors such as stigma and healthcare accessibility, which appear to be driving drug-related harm. Based on the findings, recommendations are made for systemic change, represented by comprehensive, community-driven interventions to address structural inequalities, and improve access to support services.

Objective: Bullying has consistently been highlighted as a risk factor for youth self-harm. Less is known about associations by bullying sub-type (i.e., physical, verbal, relational, cyberbullying), among boys and girls in diverse urban populations. This study aimed to explore: (1) prevalence of bullying and lifetime self-harm; (2) cross-sectional associations between bullying and self-harm. Both aims investigated bullying sub-types and the role of sex.

Method: Baseline data on bullying victimization and lifetime self-harm were drawn from REACH (Resilience, Ethnicity and AdolesCent Mental Health), an accelerated cohort study of adolescent mental health in London, United Kingdom. Data on baseline self-harm and sex were available for 3,060 adolescents aged 11-14 years (M_age=12.4, 50.6% girls, >80% ethnic minority groups) from 10 schools.

Results: Prevalence of bullying in the past six months was 22.3% and lifetime self-harm was 16.9%. Both were more common in girls than boys (adjusted risk ratios: bullying, 1.13 [1.02,1.25]; self-harm, 1.45 [1.03,1.86]). By bullying sub-type, prevalence estimates ranged from 4.1% (cyberbullying) to 16.6% (physical bullying). Bullying was associated with self-harm (aRR 3.35 [2.89,3.82]) for both girls (aRR 3.61 [3.07,4.14]) and boys (aRR 2.96 [2.27,3.65]), independent of sex, age, free school meals and ethnic group. All sub-types were associated with self-harm (aRRs 3.16-4.34), for girls and boys.

Conclusions: These baseline findings underline the importance of exploring nuances between bullying sub-types and self-harm, by sex or gender.

Objective: We use 2021 data to compare the demographic patterns of adult White and Black gun ownership with their respective race-specific rates of firearm, non-firearm and total suicide, and the percentage of suicides using firearms.

Methods: Data on gun ownership came from a nationally representative sample of over 19,000 respondents to the 2021 National Firearms Survey. Both race-specific gun ownership and suicide rates were stratified by respondent demographics-sex (male, female), census region (Northeast, South, Midwest, West), urbanicity (metropolitan or non-metropolitan), and age (18-29, 30-44, 45-59, 60+).

Results: White adults reported higher rates of gun ownership than did Black adults (33% vs 24%) but a firearm was used in a similar percentage of suicides (56% vs 58%). The demographic patterns of gun ownership of White and Black adults were similar-those least likely to report owning firearms were females, those living in the Northeast, residents of metropolitan areas, and younger adults. But the suicide patterns were somewhat different-whereas suicide rates among White adults were highest among older Whites and among Whites in non-metropolitan areas, suicide rates among Black adults were highest among younger Blacks and similar in metropolitan and non-metropolitan areas.

Conclusions: The self-reported levels and patterns of Black gun ownership cannot explain why such a high percentage of Black suicides are firearm suicides or why firearm and total suicide rates of Black adults fall so dramatically with age.